a paper presented at the
26th Conference on New York State History, June 9-11,
2005, Syracuse, NY

My primary motive in
writing this paper is to alert historians to the
contemporary descriptions of the urban environment that
arose from efforts to discover the causes of the
epidemics. My paper tries to place these works in some
context. Since they are not readily available, I have
placed excerpts from four of them on line. Click the
author to go to the link: Richard Bayley, Valentine Seaman, Elihu
Smith, and A.B. Other information about these epidemics can be
found on my My yellow fever web page.

The yellow fever epidemics that struck port
cities between Norfolk, Virginia, and Newburyport, Massachusetts,
in the 1790s are generally glossed over by historians as
aberrations, as indeed they were.(1) Yellow fever is
not a disease of temperate latitudes, but that was scant solace
to those terrorized by the epidemics, and this now obscure
tropical disease became a major medical topic of the day. In the
preface to his 1855, 767 page book on yellow fever, Rene Laroche
opined that in past sixty years as much was written about yellow
fever as any other medical topic,(2) most of it
proven wrong by modern medicine. However, in New York City
especially, self-appointed researchers as well as sanctioned
committees, scoured parts of the city block by block searching
for the causes of the epidemics. To be sure 18th century etiology
of diseases can seem bizarre to us today. Benjamin Rush, for
example, published a list of over a dozen vegetables said to
cause fevers when they rotted.(3) However, by
taking their suggested causes seriously, we can learn how people
in the 1790s related to their environment because they saw many
infectious diseases, especially seasonal fevers, as a consequence
of an imbalance between people, their community and nature. By
trying to see a fever epidemic through their eyes, the seemingly
simple "walking city" of the late 18th century is
thrown into relief, from the quays to the bedrooms. However,
causes could also be far reaching. In 1799 Noah Webster, then a
newspaper publisher in New York City, wrote a two volume work to
prove that the recent epidemics were caused in part by a volcanic
eruption of Sicily's Mt. Etna in 1789.(4)

What we know today about yellow fever, a virus
spread from person to person by the urban-dwelling Aedes aegyti
mosquito, was not known in the 1790s. That can make sifting
through the rationalizations of the 1790s akin to decoding a
farce. But if we assume a position of superior knowledge, let us
humble ourselves by recalling that those who battled yellow fever
in the 1790s had one up on modern commentators. At a 1986
conference on the treatment of yellow fever, not one of the
doctors attending had ever seen a case.(5) From the
descriptions of the course of the disease in the 1790s, we know
that the it often began with a sharp headache and a rapid decline
to prostration, with, for some, the skin turning yellow, and, for
about ten percent of the victims, death, always, it was often
said, accompanied by black vomit.(6) There could be
many particular agonies. On September 8, 1795, a delirious
William Dewitt, a baker on Whitehall Street across from the
Battery, was brought to Bellevue, which was organized by New York
City as the hospital for fever victims, and nothing the doctor
did could help. Early the next morning nurses found Dewitt had
escaped and lay naked inside a nearby summer house. He was dying
yet that afternoon had the strength to chase other patients with
a club. It took three men to subdue him and push him into a
little room where he died two hours later. One of the first
patients brought to Bellevue, a doctor wrote in his diary, was
"in a shocking condition - 10th day of the disease -
vomiting blood by the mouthfuls." He died in two hours.(7) The classic picture of an epidemic, a line of prostrate
bodies, a handful of harried health care workers, the periodic
removal of the dead, doesn't suit yellow fever. This was a
shocking disease that could make victims monsters. No symptom
seemed subtle. Vomiting blood out of the mouth was the half of
it. Blood could also come out of any orifice, ears, nose, uterus,
pores. Hiccuping could be incessant, demonic. Needless to say
treatment was problematical. In late September 1795, Elihu
Hubbard Smith joined another doctor in trying to cure the
apothecary Nathan Webb with bleeding and purges. Their patient
suffered one of the worst side effects of venesection in yellow
fever. "We were near an hour employed in attempting to stop
a bleeding which took place from a vein which had been opened
before," Smith wrote in his diary. "The blood was
entirely destroyed in its texture; the man stupidly insane; the
house deserted; a negro nurse only remaining; except a drunken
relation of the landlord, who with oaths & imprecations,
refused to allow our moving the sick man, from an apartment five
feet wide by twelve long, into an unoccupied, airy room. We did
it however - & exerted every thing in our power to restore
sensibility & hope to a man, thus forlorn, & without
relation or friend near him, to yield any assistance." Webb
died the next day.(8)

A graduate of Yale College, and already a noted
poet, Smith turned his back on literature to devote his life to
medicine and try to discover the cause of the recent epidemic.
"I went on to Bunker's-Hill, this morning," he wrote in
his diary on October 20, 1795, "that I might survey the
town, in all its parts, advantageously, and at my
leisure...."(9) Smith did not climb Bunker's Hill without
preconceptions. He had just read Benjamin Rush's memoir of the
1793 epidemic in Philadelphia. This was the first work published
on yellow fever by an American, even though the country had a
long history with the disease. Philadelphia and New York City had
yellow fever epidemics in 1699 and 1702 respectively,(10) and the disease appeared again in the 1730s and 40s,(11) but after a yellow fever epidemic in Philadelphia in
1762 killed "several hundred" people, these cities and
neighboring ports avoided the scourge.(12) Indeed a
conviction took hold that epidemic fevers were diseases of the
past in the urban centers of the progressive new nation.(13) That infatuation informed New York City's reaction to
an epidemic in 1791 which killed some 100 people around Peck
Slip, and which would be largely unknown to history save that a
young doctor wrote his dissertation about it in 1792.(14) He described the epidemic disease as typhus, until
Philadelphia was struck by yellow fever in 1793 and he realized
that it had been yellow fever.(15) The 1791
epidemic was not publically mentioned until it ended. During the
fall of 1791 New York newspapers reported on epidemics in
Lincolnshire, England, and Constantinople, but not on their own
sickness.(16) This was typical of the time. In hometown newspapers,
to avoid quarantines and protect a city's reputation, so
important as cities competed for business, the first word about a
deadly epidemic was often the all clear.

During Philadelphia's 1793 epidemic, which
killed upwards of 5,000 in the city of 50,000, the number of
deaths made obfuscation impossible though not a few insisted
until mid-September that the city was only experiencing a bad flu
epidemic.(17) That reaction was in part to defeat the efforts of
other cities, especially New York, to completely quarantine
Philadelphia. In New York there were citizen patrols in every
ward pledged to ferret out any refugees from Philadelphia so that
the contagion of yellow fever would not be introduced. The
governor's Health Committee organizing the effort thought in
retrospect that such vigilance likely saved the city from
tragedy.(18) The Philadelphia epidemic inspired debates that would
rage in medical circles for another one hundred years: was yellow
fever contagious, and was the fever imported from the West Indies
or did it arise from mephitic matter in the city?(19) Benjamin Rush and others blamed a load of rotting
coffee dumped on the Arch Street wharf for sparking the
Philadelphia epidemic.(20) The answers to these questions were fraught with
political overtones. In Philadelphia commercial interests
objected to Rush's theory and insisted that yellow fever was
contagious and imported from the West Indies.(21) As they learned more about the disease, doctors
realized that yellow fever was less contagious through person to
person contact than they originally thought, and thus dependent
for its spread only on local environmental conditions.(22) There soon developed a politically acceptable middle
view in this debate: the disease was not contagious and thus
quarantines of infected cities were not warranted, and the
disease was generated by local conditions that could be isolated
and ameliorated, and thus infected cities need not be evacuated.
Business could go on as usual, despite a deadly epidemic. New
York City would champion this view, but only when it was itself
infected. In 1794 a merchant died of yellow fever in New York,
but he had just come to the city from New Haven, where there were
reports of an epidemic. New York City quarantined ships and
people from that neighboring port. Seventy eventually died in the
New Haven epidemic(23) and 200 to 300 died in a yellow fever epidemic in
Baltimore.(24)

In late July 1795 New York's port physician,
Dr. Malachi Treat, got a fever immediately after inspecting the
Zephyr, a ship from the West Indies that had three crew members
sick with fevers. The ship's boy died the day Treat boarded the
vessel, and Treat died a few days later.(25) The Health
Committee was prepared, opening a fever hospital in a house
called Bellevue about a mile up the East River that they had
purchased in the spring. But the committee denied that there was
a yellow fever epidemic. During the whole of August it encouraged
a vigilant lookout for infected ships and cleaning the
"streets, yards, cellars and markets" near the East
River. Yet it insisted that these were wise precautions for any
hot season.(26) On August 15 it reported that only 14 had died from
fever the week before "in this large and populous
city." In the next three days, seven more died. The
committee issued its usual upbeat assessment, what apprehensions
there were in the city arose from "the peculiar sensibility
of the public mind, arising from the late suffering of
Philadelphia, New Haven and Baltimore."(27)

Doctors cooperated with the committee. On
August 15, they met, and reported to the newspapers "that no
CONTAGIOUS fever, in any particular different from what this city
has been accustomed to, for some years past at this season,
exists at present."(28) Soon after the meeting Dr. Valentine Seaman went into
the infected area of the city, and reported to the health
committee that he had found "the cause of the present
complaint,... a fruitful matrix generating the seeds" of the
fever. The city corporation had built up Water Street in that
area with landfill without requiring lot holders along the street
to fill their yards to a level with the street. "Hence, the
refuse water and offal substances from the families occupying
these places are left to stagnate and putrefy." Seaman
thought if the problem was "not properly cared for,"
more would die in the vicinity.(29) Members of the
Health Committee investigated and ordered ditches filled and
rotting cotton and coffee removed from one store. When the
committee learned that 11 people had died of the fever on the
25th, it ordered more stores cleaned. In its report on August 28,
the committee noted those clean-ups and re-iterated that
"the disorder which exists principally, if not altogether,
along a part of the Eastern shore of this city, is a local
malady."(30)

On the 31st Pennsylvania Governor Mifflin
ordered a quarantine for ships from New York. His action was
applauded in Philadelphia. New Yorkers were dumfounded. A
merchant with a store in the infected area reported that
"business continues there as lively as ever: men, women, and
children continually walking the streets, under no apprehension
of danger."(31) One newspaper wit wrote to "A Friend in
Philadelphia" that "We are all popping off here like
rotten sheep. Two hundred carcasses have been burned at the
Battery - 500 hanged for fear of catching yellow fever, and about
35 or 40 guillotined - all the windows in town are broken by the
firing of cannon.... Pray send us about 100,000 dollars to stop
the contagion, and it may compensate us in some measure for an
attempt to make our vessels ride 40 days quarantine in European
ports."(32)

New York's governor John Jay sent Mifflin
letters from the Health Committee, medical society and common
council to assure him that the city had never been healthier at
that time of year. The medical society reported that the fever
had never been contagious, and with cloudy, cooler weather, was
fast disappearing.(33) The health committee began publishing the number of
fever deaths each day, and tried to explain them away, noting
that "a large proportion of the deaths hitherto reported
have fallen among emigrants lately from Europe, strangers, and
other transient persons."(34)

Then in mid-September the situation changed.
However, the city's panic was reported in Philadelphia
newspapers, not in New York. "My God! what a change.... The
fever is spreading fast," exclaimed a letter dated the
September 17. "Forty three persons have died with it in 3
days; agreeably to the report of the committee, and how many more
God only knows. My family are gone to Long Island. I shall remain
till a stop is put to business."(35) In his diary
Elihu Smith noted the alarm:"Wherever you go, the Fever is
the invariable & unceasing topic of conversation.... People
collect in groups to talk it over, & to frighten each other
into fever, or flight." Smith thought the number of people
who had fled the city "cannot be less than 12 or
15,000."(36) New York editors did their best to remain upbeat. Rain,
winds and cooler temperature on the 21st prompted the hope that
"the city will be clear of sickness in a few days.... Broad
street, Broad way, all the north of the city, and many other
parts, are as healthy as usual." A doctor wrote that he had
scientific proof that the epidemic would soon end. The
thermometer dropped to freezing on September 21. But the health
committee recorded 32, 31, and 29 deaths on the 25th, 26th and
27th.(37) The deaths continued into October. Several prominent
men got the fever, but they survived.(38) The Health
Committee reiterated that mostly emigrants and poor living in the
low lands along the East River died. It broke down the 380 deaths
it recorded in September by profession, "only 5 or 6 [were]
well known and established merchants," and the committee was
careful to note that the one preacher who died did not belong to
a respectable denomination. (He was a Methodist.) Yet, not until
October 22 could the committee announce the end of the epidemic,(39) and on November 4 the committee published a long letter
congratulating itself for "undeviating veracity" which
subdued the terror despite "falsehoods [that] have been
propagated from the basest, meanest, and most despicable
motives." The official count of fever deaths was 730, only
150 were "citizens," and "nearly one half the city
has either wholly escaped, or experienced only here and there a
scattered case."(40)(read the report)

Within a year, three physicians and a layman
critical of their essays, published their opinions on the origins
of the epidemic. Prior to the germ theory of modern medicine,
most diseases were assigned four classes of causes: remote,
proximate, predisposing and exciting. Remote causes were often
environmental but a previous illness could be a remote cause.(41) Proximate did not refer to the neighborhood but the
body. For example, Rush thought "the state of the blood
vessels" was the proximate cause of fever.(42) Predisposing causes included the weather, but also
race, nationality, diet and morals. Exciting causes, of course,
were not bacteria or viruses, but often quite innocent mistakes,
like indulging in a bite of beef when a deadly epidemic was in
the air.(43) However, the remote cause of all summer and autumnal
fevers was generally thought to be the heat of the season acting
on poorly drained areas, be they marshes or urban puddles.(44)

In New York all three doctors focused their
attention on the low ground along the East river, especially the
"new made-ground" claimed from the river by Dutch
methods to allow for the expansion of the port and commercial
facilities. Dr. Richard Bayley estimated its extent to be about
50 acres from Whitehall to Catharine-street, "on average,
four hundred feet in breadth." Bayley described the line of
the streets parallel to the river and the slope of the streets
running into river, finding a continuum of poorly drained land
from which the fever could be generated and spread throughout the
district.(45) Dr. Valentine Seaman pinpointed where the fever began
and described, though unfortunately never made, a colorful map of
how the fever radiated through the district so "that the low
ground in the southeast of the city as above mentioned, would
appear as the grand center of the calamity, diffusing its
effects, like diverging rays, to the adjacent parts; aiding by
its most powerful influence, different secondary centers, already
smoking hot, to flame out its pestiferous operations."(46) Dr. Elihu Smith called less attention to the direction
of the streets, then to how they bounded a sunken area.
"Thus you will perceive," he wrote, "that the part
of the city where the fever was most active, for the longest
period, forms, as it were, a basin, having its side, nearest the
water, a little inclined." Within this basin, there were
several smaller cavities that, he wrote, seemed "contrived,
by art, for the dwelling place of fever." He christened one
cavity the "court-yard of the palace of death."(47)

As long as humans have been tormented by
mosquito borne diseases, they have recognized that low, wet
ground could be unhealthy, without, until the mid-19th century,
suggesting that the mosquitoes had anything to do with it.
Ironically, the doctors mentioned mosquitoes as being numerous
and tormenting especially in the fever district.(48) However, describing a low wet area was not giving a
cause sufficient in itself, after all just north of this area was
an extensive swampy district.(49) In the urban
context a few feet could make all the difference because of what
could collect in small spaces. Describing Water Street from
Peck-slip to New-slip, Bayley noted that in many places there was
a ridge just two feet high behind houses making the "an
accumulation of filth... almost a necessary consequence. Water
will frequently become stagnant, and this containing animal and
vegetable matters, exposed to the hot sun, must prove a fruitful
source of noxious vapours. Under these circumstances, it is
natural to expect that those who are exposed to the influence of
such foul air, should feel its effects..."(50)

Seaman thought the lower end of Dover Street
was the source of the fever and did not stint in trying to
pinpoint the exact spots: "several store-houses and
granaries, built partly over water with piles, without having
space under them filled up." Partitions under the stores
prevented "the free circulation of the tide from washing
away any thing from under them," causing "the
fermentation of the putrefactive materials" including
"the showers of grain that frequently would pour down
through holes that the rats sometimes would gnaw in the
floor." There was proof enough in the mere association of
these conditions. "Hence there can be no wonder,"
Seaman concluded, "that the seeds of this disease should
ripen in such a hot bed of putrefaction, aided by the effluvia
emitted from the great flats of mud in the several surrounding
impaired docks, left bare during the recess of every tide. It is
remarked that several persons employed in a large grain store
house, thus situated over such a source of noxious miasmata, were
among the first victims of the disease."(51)

Smith called attention to temporary impediments
to drainage. "In all the streets where buildings were going
forward, the workmen were allowed to restrain the course of the
water, in the gutters, by forming little dams, for their
convenience in making their mortar." Of course, building was
occurring throughout the city, but Smith was able to even turn
that fact into an argument for how the environment confined the
epidemic. On Broadway, "one of the streets the best
calculated of any in the city for free ventilation," where
workers were building the new Tontine Tavern, "the stench
was exceedingly offensive, and.... allowed to remain for near two
months; though it was almost under the windows of the principal
magistrate of the city. If this were true of the widest, and one
of the best aired and cleanest streets, of New-York, what think
you was the state of those narrow, crooked, flat, unpaved, muddy
alleys, mentioned above?"(52)

Smith's impolitic aside suggests that these
doctors were not influenced by the political imperative so
apparent during the epidemic that this be considered an
affliction confined to the east side of the city. The doctors'
inclination not to thoroughly investigate why people outside
deadly zone they described got the fever arose from the standard
approach to epidemiology then. Seaman simply insisted, without
pinpointing the areas, that places outside the zone where there
were several cases, also had offensive puddles of filth, and
where there was no evident filth, the person infected must have
come too close to filthy area.(53) Bayley and
Smith fell back on a tradition as old as medicine itself. When
the spread of disease could not be strictly explained by person
to person contact or nearby putrefaction, it was assumed that the
"constitution of the air" in and surrounding the area
of the epidemic could induce illness in anyone who excited his or
her weakened body through over exertion or over indulgence.(54) Using his cavity metaphor, Smith described the diseased
air as slowly overflowing the sunken district and suggested it
may have overspread the city if all had not been purified by the
frosts of October.(55) All of the doctors pointed out that the east side of
the city did not receive the refreshing winds that the higher
areas of the city experienced, and they noted that the layout of
the quays on the east side caused eddies of putrefying material
when the tide went out.(56) These investigations were so empowering that, guided by
Smith, newspaper publisher Noah Webster solicited reports on
diseases and environmental conditions elsewhere in the country.(57) Smith's essay was printed in a compilation of essays
edited by Webster which included reports on the epidemic in New
Haven and another of a bilious fever in Sheffield, Massachusetts.(58) In 1797 Smith and his colleagues began publishing the
Medical Repository, a quarterly scientific magazine dedicated
primarily to elucidating the environmental causes of fever in the
United States.

Of course, these doctors recognized that the
environment could not explain everything. Like the Health
Committee they noted that the epidemic was largely confined to
the city's recent emigrants. Smith speculated that the poor Irish
especially "coming from a cooler country, in crowded
vessels" were most predisposed to catch the fever,
especially since they had to change "a vegetable, for an
animal diet... and the little they have bad, and badly cooked;
hard laborers and hard drinkers, fall the first and most numerous
victims to disease." But even here, the environment was a
powerful factor in shaping the epidemic, since the emigrants
lived "in narrow and nasty streets, on the border of our
worst slips and docks; in cellars; or half-underground
rooms." And Smith saw this combination of powerful
predisposing and remote causes as changing the very nature of the
disease, making it worse since "these circumstances of
themselves are enow to convert what would otherwise be only a
simple remittent, to what is now denominated a malignant
fever."(59) Led by Benjamin Rush, it was then the fashion to
dismiss the idea that specific diseases had particular causes.
Instead, a fever could evolve in one person through several
states with yellow fever and plague being the most malignant, a
cut above typhus and then the common intermittents or malaria.(60)

These essays, Smith's especially, seem not
unlike those written a hundred years later, when social workers
and muckraking journalists left their campuses and mid-town
offices and descended on the city's slums. However, in actuality,
Smith lived right on the outskirts of the area he so maligned, in
an equally poor part of town.(61) New York City
in the 1790s was very much a walking city. This idea was
suggested by Sam Bass Warner in 1967 to describe cities in that
day when everything one needed was within a radius of a mile.
While recognizing differences in class, race, and nationality,
Warner suggested the smaller compass of the city allowed for more
amiable relations between disparate groups. This idea has been
challenged by other scholars who have shown class antagonisms
created zones where certain groups were not welcomed and did not
go.(62) The yellow fever epidemic of 1795 certainly drew a line
across the city which many people would not cross at least in the
summer and early fall.

However, Smith's, Seaman's and Bayley's views
of the epidemic were soon challenged, and in a way that helped
make the city seem somewhat whole again. In the early summer of
1796 a series of seven long letters on the 1795 epidemic, signed
by "A.B", were published in the New York Gazette and
reprinted in the Philadelphia Gazette. Drs. Bayley, Seaman and
Smith took great pains to prove that yellow fever was not brought
by ships from the West Indies.(63) A.B. made the
case that it was, by being even more particular than the three
doctors in describing conditions along the waterfront. When the
doctors catalogued the nuisances in the dozen or so affected
streets, they described "dirty wooden houses"
surrounded by sinks of miasma. To make his case, A.B. described a
block of Water Street as having "eighty-five
dwelling-houses, mostly on the north side: of those eighty-five,
twenty-eight were taverns and boarding houses." A. B. did
not gloss over the filth in the streets and in yards, nor the
overcrowding, but instead of like Seaman describing vignettes of
putrefaction, A.B. gave evidence of a close connection between
the first people to get the fever and the vessels with sickened
crews from the West Indies: "I was informed by a near
neighbor of a woman who died of this fever, August 3, in a house
nearly the opposite the foot of Dover-street, whose situation was
high, open, and dry, that it was judged she caught the fever,
from infection in some goods she had purchased from the sailors
belonging to one of those vessels, or from their cloathing, while
in her shop." There were high, airy rooms in the low part of
the city where native New Yorkers died whose connection with the
disease was not through filth but through contagion. However,
after establishing that ships brought the "seeds" of
the fever, A. B. showed street by street, how unclean and crowded
conditions, allowed the fever to spread. Yet when he reached a
street that had been kept clean by the efforts of the residents,
he too relied on the old saw, bad air, to explain why people
there got sick and died.(64) (He too mentioned mosquitoes but didn't blame them for
the spreading the disease.(65))

A.B.'s more particular account of the
epidemic's spread did not convince the proponents of local
origin. A conclusion of their analyses was that yellow fever had
been and would continue to be generated in the city whenever
environmental conditions deteriorated in the late summer. So in
1796 when there were cases reported near Whitehall, a higher part
of the water front, to the west of the low district, often
exposed to the west winds, both Bayley and Seaman studied the
disease and found evidence to support their arguments that yellow
fever was, as Bayley put it, "that murderer of our own
creating."(66) Indeed, Bayley boasted of virtually predicting an
epidemic near Whitehall, when, in April, he observed the type of
fill used for some new-made ground to extend a large dock further
out into the river. In July the fever first attacked sailors on a
Danish ship that had just docked, and Bayley showed that the
sailors sickened after they disembarked. Neighbors complained of
the stench coming from the dock fill, in which there were said to
be three dead horses.(67) By order of the Common Council "a new surface of
wholesome earth" was placed on the dock. Thanks to that, a
series of days with strong winds and a thunderstorm with much
lightning, Bayley thought the area was purified and the epidemic
was nipped in the bud.(68) Seaman also studied that outbreak and also another
small flare up in the summer of 1797 in George Street. In his
report this time he did more than talk about a map of the
epidemic. He made two maps of affected areas each covering four
blocks along the waterfront. He marked the house where people
died of the fever, naming the victims and where they lived. He
could trace every case, but one, to putrefying animal and
vegetable matter in streets or yards. That one exceptional case
he could only characterize as "a mystery."(69) He opined that the disease did not spread through out
the low areas of the city because good policing kept the areas
much cleaner.(70) Seaman also examined ships with sickness on board and
concluded it was "probable" that "an enlivening
spark from abroad" started the epidemics.(71) The fact that one of his maps vividly showed how
closely fever victims were clustered around where ships were
docked,

perhaps prompted him to modify his former
stance that incoming ships had nothing to do with the epidemic.

It is not uninteresting to step back and
contrast the alarms about epidemic disease which are so prevalent
today, despite modern methods of detection and vaccination, with
the confidence of the mid-1790s when doctors thought deadly
epidemics could be controlled simply by manipulating the
environment and regulating people's behavior. Although it did not
have the acres of new-made ground that New York City had, that
could be blamed for engendering fevers, Philadelphia did have
alleys in most city squares, many crowded with poor people in
small houses, which, while they didn't divide the city neatly
into healthy and sickly zones as in New York, did give doctors
and city officials confidence that quick action in infected
squares could prevent another epidemic like the one in 1793. In
1794, 95, and 96, Benjamin Rush cited sporadic cases of yellow
fever in the city as proof of its domestic origin and urged
isolating and cleaning infected areas.(72) When yellow
fever struck again in 1797, the Philadelphia Board of Health and
the governor announced an energetic plan of action, including
roping off and evacuating infected neighborhoods and putting
yellow flags on the doors of infected houses. Unlike in New York,
the geography of the relatively flat city laid out on a grid did
not make it easy to recognize infected area, so the city
authorities would mark them. The governor ordered
"camps," 20 to 30 tents set up in a common between
Broad Street and the Schuylkill, well away from infected areas,
to accommodate those healthy people who were evacuated. The sick
were taken to a fever hospital outside the city. Twenty-four
health wardens picked by the Board of Health enforced regulations
and sent people to the tents and the fever hospital.(73) The general public reaction to news of a epidemic was
flight. The generally accepted count was that by the end of
August, 35,000 people had left the city.(74) Meanwhile, in
the city the effort to treat the epidemic as an environmental
phenomena that could be isolated failed. Many doctors attacked
the Board of Health for precipitate action in removing patients.
Unknown parties began removing the yellow flags the board placed
on infected houses and tore down the barricades the board placed
around infected areas.(75) The view that yellow fever was a local disease got a
boost when deaths began to concentrate in Southwark and
Kensington, poor areas just outside of the city, and Rush could
argue that cases in the city proper "were easily traced to
the above sources."(76)

The mistaken environmental view of disease,
that prompted doctors and many city officials to divide cities
into districts disposed to support epidemics and those that could
be kept entirely exempt from them, did not serve the public well
in 1798, especially in New York City. The first public reports of
the return of yellow fever were in Philadelphia in late July.Although disagreeing as always on
how the fever was introduced into the city, doctors all agreed
that the infected area on Water Street between Walnut and Spruce
should be evacuated and the city be kept scrupulously clean. The
Board of Health followed the recommendations. The area evacuated
was small enough, so the consternation of the year before was
avoided.(77)

Then someone died on Walnut Street beyond 3rd
Street, and trust in scientific control of the epidemic ended.
"The fever spreads like wildfire," a resident wrote on
the 8th. "It is now at the corner of 4th and Walnut Street -
and the corner of 3rd and Walnut so that we cant go out of doors
without danger. It is appearing in every quarter of the
city."(78)Rush
thought the fever spread more in one week than in three weeks in
'93 and '97. There had been evacuations of affected cities during
all the epidemics, to date, but for the first time, on September
1, the Philadelphia Board of Health urged residents to leave the
city. Both the government and private charities organized housing
for the poor in tent and wooden cabins outside the city.(79)

In New York the first victims
lived near Coenties wharf. Residents blamed sick sailors on a
ship just in from Haiti for spreading diseases. Doctors pointed
out that ships from the West Indies docked all along the
waterfront, and that Coenties wharf had a small outbreak of
sickness the year before, and recommendations that the area be
cleaned up were not followed.(80) Then after torrential rains on August
14 reports came in of rotting meat in cellars in Pearl Street.
The Health Committee ordered the meat removed from the city.(81) On August 28 the Health Committee
reported that the sickness near the wharf had ended but
"unhappily" had popped up in other areas,
"principally in unventilated situations."(82) The committee did not even think of
recommending evacuation of the city, nor did it provide tents for
people who wanted to leave the infected area. A writer privy to
the thinking of the Health Committee wrote a long report for the
newspapers in which he cited clusters of local cases and causes
for each: new made ground, crowded buildings, offensive sewers,
and/or swampy lots.(83)
While thousands evacuated the city, the official view of the
epidemic remained that it was local, and the letters of those who
stayed in the city reflected this. New Yorkers clung to every
healthy block as evidence that it did not have as bad an epidemic
as its rival port. By avoiding docks and wharves,(84) or staying between Trinity Church and
the upper part of the Battery, one could feel safe.(85) But the relentless progress of the
epidemic undermined efforts to minimize its impact. When the
epidemics ended with the coming of frost in late October, the
official death toll in Philadelphia was 3,645(86) and in New York City 2,086.(87) There were also yellow fever epidemics
in Boston, New London, Chester and Wilmington. In one private
letter, based on the assumption that official tallies of the dead
missed many victims, an estimate of the toll for the whole
eastern seaboard was 10,000.(88)

These epidemics quite
overwhelmed scientific commentators. Not a few died of the fever,
including Elihu Hubbard Smith, a few days after he wrote to
Benjamin Rush that since "the complaint is in great measure
local, and the inhabitants of the pestilential district having
mostly fled, the extension of the sickness is not greatly to be
apprehended."(89)
Instant histories of the epidemics in Philadelphia and New York
were written by journalists;(90) a doctor's memoir of the Philadelphia
epidemic was in large part a compilation of newspaper reports
with few medical conclusions drawn from them.(91) There was an evident loss of confidence
in the ability to pinpoint the source of disease in the urban
environment. A grieving medical colleague of Smith's expanded the
indictment of the poor from not just their living conditions but
to their whole way of life. "If some of our citizens
breathed air as pure and balmy as the breezes of Eden,"
Samuel Latham Mitchill wrote to Noah Webster, "they would
engender this sickness by their way of life. They would breed it
within them. To get the better of these visitations will
therefore require more than municipal regulations. An alteration,
and a considerable one too, of housekeeping and modes of life
will be necessary."(92) In his search for causes, Webster
struck out in the other direction. Not the individual poor, but
the entire world was diseased because of a change in the
atmosphere arising from recent volcanic eruptions and
earthquakes. This pattern was evident in history and if history
was any guide, this epidemic constitution of earth's atmosphere
could continue for many years.(93)

Those in charge of public
policy could not engage in airy speculation, and both
Philadelphia and New York continued to police areas of perceived
contagion. Since Philadelphia was so flat, with generally gentle
slopes to low lying areas on the river, basing policing on the
terrain gave way to house by house inspections by volunteers in
all wards of the city.(94) A committee with the three
commissioners of health, three members of the medical society,
three members of the chamber of commerce and four aldermen
investigated the causes of the New York epidemic and recommended
reforms. It maintained the stance taken in 1795. The sources
producing the fever were "filthy sunken yards, where the
offals of the house and wash of the kitchen be until the earth
absorbs or the sun exhales them - lengthy sewers without floors,
and of little descent - foul slips exposed to the sun great part
of the tides - decaying docks out of repair - vacant water lots -
ground under stores and houses built on piles or timber, and
running bare part of the time - these are generally receptacles
of every description of impurity and carrion."(95) What was notable as the committee
amplified on these causes was that they were not described as
only pertaining the 50 some acres of low ground so minutely
examined after the 1795 epidemic.(96) The torrential rains on August 14 that
flooded cellars rotted meat in more than just the cellars of
Pearl Street. The problem had been city wide and not recognized
at the time. This meant city had to police not just low areas and
the houses and stores there, but cellars anywhere in the city.(97) The reforms recommended were draconian
including the banning meat packing south of Corlaer's hook and
not even oysters should be brought into the city between May and
October.(98) The major recommendation, a system to
supply "fresh water" to the city, was aimed to purify
the whole city, not just what were once thought to be the usual
haunts of the fever.(99)
The committee recognized that one implication of the belief that
the epidemic was local and able to be confined led to preventable
loss of life. In preparation for future epidemics, it recommended
that tents should be provided for people in infected areas who
had no place else to flee.(100) During the 1798 epidemic the city set
up soup kitchens in the infected areas encouraging people to
stay.(101) The death toll finally was high enough,
the list of victims varied enough, that New York officials
realized that even with ventilated rooms, clean gutters and soup
kitchens, which according to the medical science of the day
should have obviated the remote and predisposing causes of the
fever, an epidemic could still spread and the business of the
city had to be put on hold and people moved to safety.

The reaction to the epidemic of
1798 could have been a prologue to a major change in the American
way of life. The zeal for inspecting houses and the wide spread
displeasure with the manner in which certain people lived were
quite bipartisan. The Republican newspaper in Philadelphia, the
Aurora, was one of the leaders of the movement to inspect houses.(102) Samuel Latham Mitchill who inveighed at
the poor in New York was a prominent Jeffersonian politician.(103) However, while the threat of epidemics
continued to terrify New York and Philadelphia, prompting
widespread evacuations of the former in 1799 and 1802, the number
of deaths never climbed above 500 in those years. Health
authorities were pro-active. In New York, sick sailors discovered
on a ship returning from Havana on June 22, 1799, were
immediately taken to the Marine Hospital for quarantine on Staten
Island, and the ship thoroughly cleaned with vinegar and all
interior walls whitewashed.(104) Early in the epidemic the Health
Committee had to battle the widespread rumor that it
"smuggled" 15 to 20 fever victims out to the hospital
every day "that they may die snugly." It reported that
it treated 71 at that hospital and only 14 died.(105) Then in early September there was alarm
at the number of vagrants roaming the streets at a time when
"so many of our citizens have left our homes."(106) As usual the number of deaths increased
in mid-September, sometimes as much as 12 a day. Newspapers not
only reported the daily toll in New York, but Philadelphia as
well. The New York Commercial Advertiser provided a rundown of
the "State of Health in the United States," reporting
that "New York, (in the city and suburbs) sickly, but
recovering," while New Jersey was "remarkably
healthy." Reports were terse, for example, "Virginia
has no prevailing epidemic at present, though many die at
Petersburgh of common disorder."(107) Such reports captured a national mood
that historians have quite neglected. In one of his diplomatic
dispatches the British ambassador to the United States, writing
from Greenwich, Connecticut, in October 1799, reported that there
were fewer deaths in New York which "some people ascribe...
to the more general emigration of the inhabitants...," but
he worried about reports that even in the countryside,
"attendants of the sick are said to have been infected by
the disease." "So that," he concluded, "there
appears to be no perfect security in any quarter."(108)

The "local malady" of
New York so confined in 1791 that it was virtually unknown even
in the city, so assuredly an environmental nuisance in 1795, had
spread its terror throughout the whole country irrespective of
what appeared to be environmental factors. During the 1798
epidemic in Philadelphia, two young socialites moved into a house
in the suburbs to escape the scourge and then to the shock of the
nation both were found dead, evidently of the fever. A friend of
the young ladies, a senator from South Carolina, asked Benjamin
Rush how that could have happened, wondering if the soil around
the seemingly safe house had too much moisture for the ladies'
delicate system to bear.(109)

The best modern explanation for
the waning of the epidemics is that exposure to the yellow fever
virus gives lifetime immunity. As with many viruses, many
infected by yellow fever do not exhibit any untoward symptoms.
The pool of immune people grew. Some medical commentators
recognized this immunity, while others, like Benjamin Rush,
claimed to have seen multiple infections.(110) As the almost annual epidemics became
smaller, medical investigators in Philadelphia tried to zero in
on causes. They published lists during the 1802 epidemic with the
name, residence, and circumstances of each known victim, for
example: "Richard Essick's boy, in Southwark or Moyamensing,
used to carry victuals to his Father, who worked at Brown's
bake-house, died on July 12."(111) But this closer focus did not unlock
the keys to epidemics' cause, and rather than look harder for
environmental factors some like Edward Miller, an editor of the
Medical Repository and once dedicated to ferreting out
environmental causes of disease, simply blamed the latitude. He
capitalized this passage in his Report on Yellow Fever, "WE
LIVE IN THE LATITUDE OF PESTILENCE, AND OUR CLIMATE NOW PERHAPS
IS ONLY BEGINNING TO DISPLAY ITS TENDENCY TO PRODUCE THIS
TERRIBLE SCOURGE." Furthermore, "impurities" on
the ground that had been deemed temporary and removable were now
seen by Miller as "moulded" by time and poor policing.
They had "been long accumulating," and temporary
clean-ups were no assurance of safety.(112)

1. The 1793 epidemic in Philadelphia rated
one paragraph in Stanley's and Elkins's, 754 page, The Age of
Federalism: The Early American Republic, 1788-1800; see page
365

6. For the most detailed contemporary
account of symptoms see Benjamin Rush, An Account of the
Bilious Remitting Fever as it appeared in Philadelphia in 1793,
Philadelphia 1794. (It is essential for a correct understanding
of Rush's work during the epidemic to read an early edition of
his work. The version reprinted by the Arno Press in 1972 was
edited by Rush to conform to his post-1798 conviction that yellow
fever is not contagious.)

18. Minutes of the Common Council of the
City of New York, 1784-1831, NY 1917, II p 203; Powell, J.
H., Bring Out Your Dead: the Great Plague of Yellow Fever in
Philadelphia in 1793, New York, 1949, pp. 223-4: Heaton,
Claude Edwin, "Yellow Fever in New York," Bulletin of
the Medical Library Association, 1946, April: 34 ( 2), p 68

22. At first Rush thought the fever was
contagious, then changed his mind, and carefully revised all his
writings on the fever eliminating any suggestion that it was
contagious.

23. Hoadley, Frederick H.., "A Review
of the History of the Epidemic of Yellow Fever in New Haven,
Connecticut, in the year 1794," New Haven Colonial
Historical Society Publication, vol. 6. 1900, pp. 223-262.

26. Philadelphia Gazette, 12 aug 1795 (This
Philadelphia newspaper provides the best running record of the
epidemic because it reprinted everything about the fever reported
in the New York City newspapers, plus letters from people in New
York that often weren't published in New York papers.)

60. Rush, Medical inquiries and
observations : containing an account of the bilious remitting and
intermitting yellow fever, as it appeared in Philadelphia in the
year 1794. Together with an inquiry into the proximate cause of
fever ; and a defence of blood-letting as a remedy for certain
diseases. Philadelphia, 1796, p..

72. Rush 1794 p 73. Rush's campaign against
the domestic sources of yellow fever was complicated by his
insistence that he could cure the disease when summoned to a
patient in time. Thus the few deaths, which led most to assume
there was no epidemic, emboldened Rush's belief in the efficacy
of his treatment.

73. Aurora 22 & 24 Aug. 1797, Phil. Gaz.
26 Aug. 1797; Folwell, Richard, Short History of the yellow
fever epidemic, that broke out in the City of Philadelphia, in
July 1797, Philadelphia, 1799. p 17.

74. John Dawson to James Madison, Sept. 7,
1797, Rutland, Robert Allen, Papers of James Madison,
1977.

77. Condie pp 47-8; Currie, William, Memoirs
of the yellow fever, which prevailed in Philadelphia, and other
parts of the United States of America, in the summer and autumn
of the present year, Philadelphia, 1798 p. 10

109. Pierce
Butler to Benjamin Rush, 14 October 1798. Rush Papers, Historical
Society of Pennsylvania. (I have not found Rush's reply but I
assume he agreed with Butler who was a close student of his
friend Rush's ideas.)